City overdose deaths drop slightly

Deaths from drug and alcohol overdose dropped slightly last year in Baltimore, according to a report released yesterday by the Health Department. The decline continues a downward trend from the peak a decade ago.

In 2007, 235 city residents died from overdose in Baltimore, down from 244 the previous year.

City health officials said the decline suggests that drug use in the city may be declining. "The numbers are most likely a reflection of how many people are using," said Caroline Fichtenberg, the Health Department's chief epidemiologist, who wrote the report. She said it wasn't clear why drug use may be dropping, but said better prevention and treatment programs may play a role.

But, experts and officials agreed, the report shows that despite the small improvement, Baltimore is in the throes of a severe public health problem.

"The drug problem is enormous," said Bill Latimer, an expert in addiction, prevention and treatment, and an associate professor at the Johns Hopkins Bloomberg School of Public Health. "The overdose deaths are an important statistic, but just the tip of the iceberg."

Baltimore's death rate from overdose of all drugs, including prescription medicines, was 35 per 100,000 in 2004. For the U.S. as a whole, the rate that year was 10.5 per 100,000. A 2003 federal report found that Baltimore had the highest rate of drug-related deaths out of 35 U.S. cities, including Detroit, New York and Washington. More recent comparative data were not available.

Sixty-four percent of the deaths in Baltimore last year were heroin-related, and 38 percent were cocaine-related. Because many of the dead ingested more than one drug, it is impossible to say exactly which substance caused the overdose.

"Polydrug cases make it difficult to know what's contributing to what," said Dr. Robert P. Schwartz, an expert on drug addiction and treatment. He is medical director at Friends Research Institute, as well as a fellow at the Open Society Institute.

The largest decrease in the city came from cocaine-related deaths, which fell from 116 in 2006 to 90. But the drop came a year after a precipitous increase, from 52 in 2005. The reasons for the rise and subsequent fall remain a mystery, Baltimore health officials said. But Fichtenberg said that she had heard anecdotal evidence, from police and other sources, that decreased supply played a role: less cocaine was being sold on Baltimore streets last year than in 2006.

"The big picture is that the 2006 increase has not continued. That's a relief," said Fichtenberg.

Baltimore Health Commissioner Dr. Joshua M. Sharfstein said he plans to focus on the kinds of drug treatment the victims received before they died. With this information, officials hope to find ways to improve treatment and reduce overdose risk. "We're trying to get a much better understanding of overdose deaths," he said. "We're looking to understand as many factors as possible."

Sharfstein and others noted that methadone deaths rose for the eighth straight year, to 74, the highest level ever.

"The methadone deaths remain really striking," said Latimer. He said the methadone deaths were in part an indication of the city's "massive" heroin problem.

Methadone deaths are rising nationally, in part because more and more treatment programs are offering the drug, and in part because doctors increasingly prescribe the drug as a pain reliever. Methadone, an opioid, can help heroin addicts kick their habit. It reduces the craving for heroin, and gives users a smaller high. But despite its relative safety, the drug poses risks.

There was one overdose death in Baltimore last year associated with buprenorphine, an addiction treatment drug that has gained popularity as a safer alternative to methadone. Some critics have warned that buprenorphine may itself pose serious overdose risks. In Baltimore, many fewer addicts are treated with buprenorphine – 300 in city treatment programs, compared with 3,900 treated with methadone.

Sharfstein called buprenorphine a "very promising strategy."

"It is an effective treatment for heroin addiction, that is much less likely to cause overdose than either heroin or methadone," he said.
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source: Baltimore Sun